DR. HOOK- Rise up! Where's Norma Rae when we need her?

Norma Rae is one of the greatest movies of all time. Sally Field deservingly won her first Oscar (pre-"You-like-me-you-really-like-me"). The Californian nailed the Southern accent by adding an extra syllable to each word, "Iiii'm Mrs. Weeeeebsteeh." When she got mad at her husband, she scurried around the kitchen like a lunatic to make her point. When the evil forces at her textile factory tried to kick her out, she yelled, "It's gonna take you and the police department and the fire department and the National Guard to get me outta here!"

Then she did an Erin Brockovich move: she wrote on a piece of cardboard, "UNION," and stood up on a work table. As she boldly held up this sign, one by one each coworker turned off his or her textile machinery until the place went silent. ("Just what makes that little ol' ant, Think he'll move that rubber tree plant...")

Norma Rae, where are you when we need you? Health insurance is failing! Well, not failing for the executives when they're making tens of millions a year, but failing the American public.

"Just sit right back and you'll hear a tale, a tale of–" the ludicrous pre-authorizations health insurance requires doctors to do in order for patients to be covered. Once in Washington, D.C. I was paged by the ER to pre-authorize a victim of a serious car accident. I replied, "No, just put a band-aid on his head and send him home," which they did. No, just kidding. I didn't really say that.

DEXA scans– to evaluate bones for osteoporosis– require pre-authorization by almost every insurance carrier. Sticks and stones might break my bones, but insurance will surely harm me. Between you and me, if men got osteoporosis as often as women, insurance would encourage everyone to get a DEXA and even provide men with cows to ensure they got enough calcium.

The beginning of each calendar year marks changes in the drug formulary. So I have patients who have been on Drug X– let's say, for five years. Suddenly I have to fill out a pre-authorization form that asks things like, "Why does the patient need this medicine? What date did the patient start it? What proof is there the patient actually has this disease? Has the patient tried other alternatives, and if so what dates and what were the outcomes?"  

When you have five billion of these forms to fill out, it makes doing taxes seem like reading a Harry Potter book by a cozy fire.

I would say half the time pre-authorizations are denied by insurance and require a doctor-to-doctor review in order to get them approved. Hahahaha! Oh, it just tickles me silly when I get these letters because it's easier to call the President of the United States than to speak to a real person– in particular a doctor– about health insurance.  

I fondly remember the time I stayed on my speaker phone for 45 minutes, and a person who is probably paid $5.45 an hour finally answered the phone and said, "Sorry, but the medical director is gone for the day. He'll call you tomorrow." What she meant was the Annie musical song, "Tomorrow, Tomorrow...."and tomorrow and tomorrow. I never get a call from the medical director— unless he's ticked off at me. 

As a practicing physician, I cannot do a Norma Rae "UNION," but I have a feeling patients will be doing it soon. Patients are tired of being declined the most fundamental things by health insurance– like medical care.